Healthcare Provider Details

I. General information

NPI: 1467604074
Provider Name (Legal Business Name): LISA MARIE WILLIAMS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2008
Last Update Date: 10/14/2022
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 KILSON DR STE 201
MOORESVILLE NC
28117-8218
US

IV. Provider business mailing address

111 KILSON DR STE 201
MOORESVILLE NC
28117-8218
US

V. Phone/Fax

Practice location:
  • Phone: 704-664-1009
  • Fax: 704-664-1029
Mailing address:
  • Phone: 704-664-1009
  • Fax: 704-664-1029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC006049
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: